Viral myocarditis should be considered in pediatric refractory ventricular tachycardia with a Brugada pattern, as early diagnosis and treatment can be lifesaving.
BACKGROUND: Sodium channelopathies predispose to life-threatening arrhythmias. Brugada phenocopies (BrPs) are nongenetic conditions that mimic Brugada syndrome and may have a reversible cause. CASE PRESENTATION: A 16-month-old child presented with a 12-day ventricular tachycardia storm and a spontaneous type 1 Brugada electrocardiogram pattern during sinus rhythm. The patient initially presented with no fever and normal ventricular function on admission that deteriorated severely within 6 days. Blood viral polymerase chain reaction was positive for parvovirus B19, and endomyocardial biopsy confirmed myocarditis. Targeted treatment led to full recovery. DISCUSSION: This is the first reported case to our knowledge of BrP caused by viral myocarditis. It highlights the diagnostic challenges and the importance of correct diagnosis and treatment. TAKE-HOME MESSAGES: In pediatric refractory ventricular tachycardia, even with a Brugada pattern (possible BrP), myocarditis should be considered, as early diagnosis and treatment can be lifesaving. Blood viral polymerase chain reaction is a highly sensitive diagnostic tool for diagnosis of viral myocarditis in children.
Bueno-Gómez et al. (Wed,) studied this question.